AB1397 WORK SMARTER NOT HARDER
Authors: K. Tempest, H. Reddy, S. Johns, K. Wright, S. Sultan
Journal: Annals of the Rheumatic Diseases (2022)

Background In 2014 we were a small team with only 1 WTE (Whole Time Equivalent) CNS (Clinical Nurse Specialist) and 2 WTE consultants for a population of 220,000. Most CNS clinic appointments were taken up for drug counselling. Waiting times were approx. 6 weeks for drug counselling. Consultants would often counsel for DMARDs. That year at a national meeting a virtual group MDT (multidisciplinary) was presented by the team at Manchester Royal infirmary (MRI). They used a good quality presentation for patients starting bDMARDs as a tool for drug counselling. After having to put on an extra clinic to counsel 5 patients, all for rituximab, frustratingly I asked why can’t I get them all in the same room to save time? We needed to work smarter, not harder, utilise time &amp; space to ensure best practice but also ensure gold standard, patient centered care continued. We modified the format used at MRI to a face to face group education and counselling of patients to improve waiting times and patient flow. Objectives Reduce the amount of clinic appointments used to counsel patients for sDMARDs (synthetic disease modifying anti-rheumatic drugs) and bDMARDs (biologic). Free up clinic appointments for follow up/ review and flares. Standardise information given out to ensure they are all given the same gold standard information and education. Methods We visited the team at MRI to view the format of their virtual clinic. It didn’t meet the needs of our service so we modified and adapted the presentation. Set up a group education session to discuss the most common sDMARDs and bDMARDs used for Inflammatory Arthritis. I developed a power point presentation and booklet that can be used by CNS- ensuring the same information is given to every patient, both attending the group session and those not suitable for group session (ie Language barriers) who would be seen individually. We use a screening proforma to ensure safety of commencement for the individual prior to attending clinics which has a tick list for screening requirements. The session is undertaken in our education centre. Pre Covid the session could accommodate up to 10 patients per session per week, uptake on average 8-10 patients for sDMARDs and 5-6 for bDMARDs. We alternated biologic and sDMARD sessions, if demand required, we changed a session to accommodate. The room is booked for 1½ hours every week, the sDMARD presentation lasts approximately ½ an hour &amp; bDMARD session 50 minutes, time is allowed for group &amp; individual questions if required at the end. This contrasts with 25 minute appointment for sDMARD &amp; 50 minute for bDMARD counselling 1:1. The booklet, along with information pack, is given at the group session to all patients. This includes all the information the patient requires (advice line information, blood forms). Prior to the group clinic admin team prepare the patient packs for the CNS to give to patients. Results We received 102 anonymous responses back from 136 patients asked. (75% response) Following these sessions we found less calls to the advice line regarding medication queries, able to add in further cDMARDs or switch to alternate due to S/Es over the telephone Feedback from patients.-120 comments received. Clear simple information about a number of possible drugs used to treat my condition not just the 1 I am prescribed. If my medication needs changing I already know about it. The lecture aspect of the types/contra-indications of meds was very useful &amp; removed the ‘fear’ attached to these specialist drugs. The session with other patients present stopped me from feeling alone in this position. The booklet is brilliant as it includes everything that was in the session. Also it took away the ‘fear’ of the side effects. Conclusion 7 years on we feel that Group Counselling has been a huge success, we noticed how successful this was once we had to deal with the pandemic and cancel the group sessions. Patients feedback proves that they like the session and find them valuable. Whilst being beneficial and impoving work productivity and streamling the service. Acknowledgements The Rheumatology Team at The Kellgren Centre Manchester Royal Infirmary Disclosure of Interests Kelly Tempest Speakers bureau: Abbvie Sanofi Galapogos, Hanu Reddy: None declared, Samantha Johns: None declared, Kathryn Wright: None declared, Shabina Sultan Speakers bureau: Amgen, Grant/research support from: lilly